title: Donor human milk for preterm infants: current evidence and research directions.
abstract: The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition aims to document the existing evidence of the benefits and common concerns deriving from the use of donor human milk (DHM) in preterm infants. The comment also outlines gaps in knowledge and gives recommendations for practice and suggestions for future research directions. Protection against necrotizing enterocolitis is the major clinical benefit deriving from the use of DHM when compared with formula. Limited data also suggest unfortified DHM to be associated with improved feeding tolerance and with reduced cardiovascular risk factors during adolescence. Presence of a human milk bank (HMB) does not decrease breast-feeding rates at discharge, but decreases the use of formula during the first weeks of life. This commentary emphasizes that fresh own mother's milk (OMM) is the first choice in preterm infant feeding and strong efforts should be made to promote lactation. When OMM is not available, DHM is the recommended alternative. When neither OMM nor DHM is available, preterm formula should be used. DHM should be provided from an established HMB, which follows specific safety guidelines. Storage and processing of human milk reduces some biological components, which may diminish its health benefits. From a nutritional point of view, DHM, like HM, does not meet the requirements of preterm infants, necessitating a specific fortification regimen to optimize growth. Future research should focus on the improvement of milk processing in HMB, particularly of heat treatment; on the optimization of HM fortification; and on further evaluation of the potential clinical benefits of processed and fortified DHM.
authors.affiliation: *Italian Association of Human Milk Banks, Milan, Italy †Division of Neonatology, İzmir Dr Behçet Uz Children's Hospital, İzmir, Turkey ‡Paediatrics, VU University Medical Center, Amsterdam, the Netherlands, and Paediatrics, Emma Children's Hospital-AMC, Amsterdam, The Netherlands §University Children's Hospital, Zurich, Switzerland ||Department of Paediatrics, University of Granada, Granada, Spain ¶Hospital Necker Paris, Paris, France #Department of Paediatrics, University of Pecs, Pecs, Hungary **Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden ††MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK ‡‡Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia §§Department of Paediatrics, Harlaching, Munich Municipal Hospitals, Munich, Germany ||||Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark ¶¶Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ##Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille, France.
authors.affiliation: *Italian Association of Human Milk Banks, Milan, Italy †Division of Neonatology, İzmir Dr Behçet Uz Children's Hospital, İzmir, Turkey ‡Paediatrics, VU University Medical Center, Amsterdam, the Netherlands, and Paediatrics, Emma Children's Hospital-AMC, Amsterdam, The Netherlands §University Children's Hospital, Zurich, Switzerland ||Department of Paediatrics, University of Granada, Granada, Spain ¶Hospital Necker Paris, Paris, France #Department of Paediatrics, University of Pecs, Pecs, Hungary **Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden ††MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK ‡‡Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia §§Department of Paediatrics, Harlaching, Munich Municipal Hospitals, Munich, Germany ||||Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark ¶¶Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ##Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille, France.
authors.forename: Sertac
authors.initials: S
authors.lastname: Arslanoglu
authors.forename: Willemijn
authors.initials: W
authors.lastname: Corpeleijn
authors.forename: Guido
authors.initials: G
authors.lastname: Moro
authors.forename: Christian
authors.initials: C
authors.lastname: Braegger
authors.forename: Cristina
authors.initials: C
authors.lastname: Campoy
authors.forename: Virginie
authors.initials: V
authors.lastname: Colomb
authors.forename: Tamas
authors.initials: T
authors.lastname: Decsi
authors.forename: Magnus
authors.initials: M
authors.lastname: Domellöf
authors.forename: Mary
authors.initials: M
authors.lastname: Fewtrell
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Walter
authors.initials: W
authors.lastname: Mihatsch
authors.forename: Christian
authors.initials: C
authors.lastname: Mølgaard
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
authors.forename: Johannes
authors.initials: J
authors.lastname: van Goudoever
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D006801:Humans; D007234:Infant, Premature; D017784:Milk Banks; D008895:Milk, Human